Patient Discharged to Nursing Home 300 Miles Away

McKnight's has reported that a Georgia hospital discharged and transported a patient to a nursing home 300 miles away, resulting in a lawsuit filed by the patient's sister. 

Johnny Lee Bryant was admitted to Doctors Hospital in Augusta, GA, in early January 2015 from  a nearby long-term care facility. He was treated at the hospital for sepsis and pneumonia for less than two weeks before he was discharged.

Instead of returning to the nearby facility, Bryant was transported by Gold Cross EMS to a nursing home nearly 300 miles away. Once there, the nursing home refused to admit Bryant.   Bryant was eventually taken back to Augusta and admitted to a different hospital, where he died in February 2015.

The lawsuit, filed by Bryant's sister accuses the hospital, the ambulance company and Hetal Thakore, M.D., of negligence, wrongful death and causing emotional distress.

For more information, go here. 

Seniors Should Review Medications for Fall Risk

Falls remain by far the leading cause of injuries among adults age 65 and older in the U.S, according to the Centers for Disease Control and Prevention (CDC).  The January Newsletter of Worst Pills Best Pills includes an excellent article warning the elderly of the importance of reviewing medication for increasing fall risk.   The article explains that: 

The most recent CDC statistics reveal that during 2014, approximately 27,000 older adults died because of falls. Overall, nearly 3 million older adults were treated in emergency rooms for fall-related injuries, such as fractures and head trauma, and about 800,000 of these patients subsequently were hospitalized. The costs to Medicare to care for patients who have been injured in falls are estimated to be $31 billion annually. And for many elderly people, fall-related injuries can lead to a loss of independence and placement in an assisted-living facility or nursing home.

Many falls are preventable. In 2011, the CDC launched an initiative called STEADI — Stopping Elderly Accidents, Deaths, and Injuries — to reduce preventable falls in older adults. STEADI provides health care professionals with tools to screen and assess older patients for risk of falls and guidance on how to reduce this risk. A key part of the STEADI program involves health care professionals reviewing and managing patients’ medications that might increase the risk of falling. 

The list of drugs that can make patients susceptible to falling is lengthy.  Use of these drugs by older adults should be avoided whenever possible, and many have been designated as "Do Not Use" by Public Citizen’s Health Research Group [link added]. Older adults requiring treatment with one or more of these drugs should use the lowest dose necessary to achieve the desired clinical benefit in order to lower the risk of falling. Note that the table does not include drugs used to treat high blood pressure, all of which can increase the risk of falling.

Seniors, their family, friends, and caregivers are well-advised to review medications regularly.   

The New Special Needs Trust Fairness Act

The Special Needs Trust Fairness Act, federal legislation that allows people with disabilities to create their own special needs trusts instead of having to rely on others, is now law.  The measure was included in the 21st Century Cures Act, a $6.3 billion package of health-related initiatives signed by President Obama on December 13, 2016. 

The National Academy of Elder Law Attorneys (NAELA)  press release announcing the Fairness Act’s clearing its final legislative hurdle, explains that the measure “corrects a patently false and degrading error in the law that presumed all individuals with disabilities lacked the capacity to handle their own affairs.”  The legislation, which Rep. Glenn Thompson (R-Pa.) introduced in 2013, will finally allow beneficiaries with capacity to create and fund their own special needs trusts with the same treatment and protections available for trusts created by others on behalf of the beneficiaries. 

In addition to Rep. Thompson, NAELA applauded Frank Pallone (D-N.J.) along with Sens. Chuck Grassley (R-Ia.) and Bill Nelson (D-Fl.) “for their bipartisan dedication to ensuring this common sense fix became law.”

The Fairness Act will apply to trusts established on or after the date that the Cures Act was enacted.  

The Social Security Administration has published an emergency memorandum incorporating the change into the Program Operations Manual System (POMS) ( with thanks to Attorney Donald D. Vanarelli, whose blog post can be found here).

The SNT Fairness Act can be found in Title V, Section 5007 (page 440), of the Cures Act.  To read the 21st Century Cures Act, click here.

Antipsychotics and Psychotropic Drugs Increase Fall Risks in Nursing Homes

McKnight's Long Term Care News reports that psychotropic drugs, including antipsychotics and antidepressants, increase the risk of falls among nursing home residents, according to a recently published study.

Previous research suggested a link between psychotropic prescriptions and falls in nursing home residents, but little was known of how "as-needed" prescriptions impacted fall rates. The study, published in the December issue of JAMDA - The Journal of Post-Acute and Long-Term Care Medicine by Dutch researchers, not only backed up earlier research, but found a relationship between falls and drugs taken on an as-needed basis as well.

Of the 2,368 nursing home residents in the study, nearly 70% had a prescription for at least one psychotropic drug per day. An additional 8.8% had an as-needed psychotropic prescription. The study's authors found that 33.5% of residents had at least one fall, which most often occurred on days when a psychotropic drug was prescribed on a scheduled basis.

Residents receiving the drugs on a scheduled basis had a nearly threefold increase in falls. An increase in fall incidence also was noted in residents prescribed the drugs on an as-needed basis. Results of the study also showed that male residents had a fall risk nearly two times higher than female residents.

Study results showed no link between fall incidence and the prescription of benzodiazepines, drugs commonly used to treat anxiety and insomnia.

An Ohio appeals court has ruled that a Medicaid applicant did not transfer assets for less than fair market value even though he sold property at below the appraised price because the sale was an arms-length transaction. Lawrence v. Ohio Department of Job and Family Services (Ohio Ct. App., 6th Dist., No. H-15-020, Sept. 2, 2016).

Eugene Lawrence owned a rental property that he could no longer maintain, so he sold it in 2011 for $22,720, which was the remaining balance on the mortgage. The auditor had appraised the property at $66,800. In 2014, he entered a nursing home and applied for Medicaid. The state determined that because Mr. Lawrence sold the property for less than the fair market value, it was an improper transfer, and it imposed a penalty period.

Mr. Lawrence appealed the decision. After a hearing, the state upheld the penalty period, and Mr. Lawrence appealed to court. The trial court found that Mr. Lawrence sold the property in an arms-length transaction, so the state should not have imposed a penalty period. The state appealed.

The Ohio Court of Appeals, Sixth District, affirmed, holding that Mr. Lawrence did not transfer assets for less than market value. According to the court, "the market conditions at the time of the sale combined with the condition of the property and circumstances of the sale demonstrated an arms-length transaction for fair market value."

Although the result is comforting for those who must plan for Medicaid eligibility, the case is instructive of the difficulties applicants may face.  The state upheld the decision on appeal to an Administrative Law Judge, but the Common Please Court held in favor of the applicant.  The applicant then was forced to defend the decision in the Court of Appeals.  Proceeding through the court system is not easy, or inexpensive.  

For the full text of this decision, go here.